胆汁反流与食管下端括约肌组织中一氧化氮及血管活性肠肽的关系

The relationship between nitric oxide and vasoactive intestinal polypeptide in lower esophageal spincteric and bile reflux.

目的探讨胆汁反流与食管下端括约肌组织中一氧化氮及血管活性肠肽的关系。方法对20名健康志愿者及86例反流性食管炎患者,进行食管压力测定、24h食管内pH、食管胆汁监测及食管下端括约肌组织中一氧化氮及血管活性肠肽含量检测;比较健康志愿者、酸反流者、胆汁反流者及混合反流者食管下端括约肌压力、一氧化氮及血管活性肠肽含量的变化。结果酸反流组、胆汁反流组及混合反流组一氧化氮及血管活性肠肽含量较健康志愿者组增多,而混合反流组较酸反流组、胆汁反流组增高(P<0.01);反流性食管炎患者食管下端括约肌压力与食管下端括约肌组织内的一氧化氮及血管活性肠肽呈负相关(r=-88.5,P<0.05和r=-89.9,P<0.05)。结论胆汁反流可导致食管粘膜炎症,食管下端括约肌局部组织中一氧化氮及血管活性肠肽明显增高,食管下端括约肌压力下降,胆汁与胃酸反流具有协同作用,加重食管粘膜损伤。

Objective To investigate the relationship between nitric oxide(NO) and vasoactive intestinal polypeptide(VIP) in lower esophageal spincteric(LES)and bile reflux.Methods The amounts of NO,VIP,24 hours pH monitoring,24h bile monitoring and pressure of LES in 20 healthy volunteers and 86 cases with reflux esophagitis were measured.The changes of the LES pressure,NO and VIP were compared in healthy volunteers,acids reflux,bile reflux,and mixed reflux patients.Results The contents of NO and VIP in the patients with acids reflux disease and bile reflux disease as well as mixed reflux increased as compared with that of healthy volunteers,which increased more in mixed reflux group than in acid reflux group and bile reflux group(P<0.01).The LESP in the patients with reflux esophagitis group was negatively correlated with loccd tissue concentration of NO and VIP^(P<0.05) .Conclusion The bile refluxing can hurt the esophageal mucosa,and make the tissue concentration of NO and VIP abnormally to increase,and decrease LESP,participating reciprocally with the acid reflux in hurting esophagus.